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DERMATITIS KONTAK IRITAN

Ahmad Amsori
Yuli Darlinawati

Pembimbing: dr. Arif Effendi, Sp.KK


SMF ILMU KULIT KELAMIN
FAKULTAS KEDOKTERAN UNIVERSITAS MALAHAYATI
BANDAR LAMPUNG TAHUN 2016
BACKGROUND
Skin and skin-structure infections are
common in ambulatory settings. However,
the efficacy of various antibiotic regimens
in the era of community-acquired
methicillinresistant Staphylococcus aureus
(MRSA) is unclear.
Tujuan
Untuk menilai prevalensi Rresistensi
Insulin, Sindrom Metabolik pada remaja
obesitas dan faktor-faktor yang
berpotensi terkait, seperti jenis kelamin,
tanda-tanda Acanthosis Nigricans (AN),
dan riwayat penyakit metabolik keluarga.
METHODS
multicenter, prospective, randomized, double-blind clinical trial of clindamycin
versus TMP-SMX for the treatment of uncomplicated skin infections
We enrolled outpatients with uncomplicated skin infections who had cellulitis,
abscesses larger than 5 cm in diameter (smaller for younger children), or
both. Patients were enrolled at four study sites. All abscesses underwent
incision and drainage. Patients were randomly assigned in a 1:1 ratio to
receive either clindamycin or trimethoprimsulfamethoxazole (TMP-SMX) for
10 days. Patients and investigators were unaware of the treatment
assignments and microbiologic test results. The primary outcome was clinical
cure 7 to 10 days after the end of treatment.
Study Population, Stratification, and Randomization
From May 2009 through August 2011, patients were recruited at four locations
(University of Chicago Medical Center, Chicago; San Francisco General
Hospital, San Francisco; HarborUCLA [University of California, Los Angeles]
Medical Center, Torrance, CA; and Vanderbilt University Medical Center,
Nashville) from urgent care clinics, emergency departments, and affiliated
clinics
Kriteria inklusi
Patients were eligible if they had two or more of the following signs or
symptoms for 24 or more hours: erythema, swelling or induration, local
warmth, purulent drainage, and tenderness to pain or palpation. Patients
were categorized as having cellulitis (defined as inflammation of the skin
and associated skin structures without signs of a drainable fluid
collection), abscess (defined as a circumscribed, drainable collection of
pus), or both (if lesions of both cellulitis and abscess were present).
Kriteria eksklusi
Exclusion criteria were superficial skin infections (e.g., impetigo), skin
infection at a body site that requires specialized management (e.g.,
perirectal, genital, or hand infection), a human or animal bite at the
infection site, high fever (oral temperature, >38.5C [>38.0C in children
6 to 11 months of age]), receipt of immunosuppressive medications or
the presence of an immunocompromising condition such as diabetes or
chronic renal failure, morbid obesity (body-mass index [the weight in
kilograms divided by the square of the height in meters], >40), surgical-
site or prosthetic-device infection, and receipt of antibacterial therapy
with antistaphylococcal activity in the previous 14 days. Patients were
ineligible if they lived in a long-term care facility, had cancer or an
inflammatory disorder that required treatment in the previous 12
months, or had major surgery in the previous 12 months
Table 1. Baseline Characteristics of the Patients, According to Treatment Group.*
Clindamycin Group (N TMP-SMX Group All Patients (N
Characteristic
= 264) (N = 260) = 524)
Female sex no. (%) 129 (48.9) 121 (46.5) 250 (47.7)
Hispanic ethnic background no. (%)
Non-Hispanic or Non-Latino 188 (71.2) 186 (71.5) 374 (71.4)
Hispanic or Latino 76 (28.8) 74 (28.5) 150 (28.6)
Race or ethnic group no. (%)
American Indian or Alaskan Native 1 (0.4) 2 (0.8) 3 (0.6)
Asian 5 (1.9) 4 (1.5) 9 (1.7)
Hawaiian or Pacific Islander 4 (1.5) 2 (0.8) 6 (1.1)
Black 141 (53.4) 138 (53.1) 279 (53.2)
White 102 (38.6) 109 (41.9) 211 (40.3)
Multiracial 10 (3.8) 4 (1.5) 14 (2.7)
Other or unknown 1 (0.4) 1 (0.4) 2 (0.4)
Age group no. (%)
<1 yr 6 (2.3) 5 (1.9) 11 (2.1)
18 yr 45 (17.0) 42 (16.2) 87 (16.6)
917 yr 30 (11.4) 27 (10.4) 57 (10.9)
18 yr 183 (69.3) 186 (71.5) 369 (70.4)
Temperature C 36.610.50 36.590.52 36.600.51
Area of wound cm2 43.84140.03 35.3571.13 39.62111.28

Purulent drainage present no. (%) 124 (47.0) 113 (43.5) 237 (45.2)
Incision and drainage performed no. (%) 122 (46.2) 111 (42.7) 233 (44.5)
Type of lesion no. (%)
Abscess only 80 (30.3) 80 (30.8) 160 (30.5)
Cellulitis only 136 (51.5) 144 (55.4) 280 (53.4)
Mixed abscess and cellulitis 47 (17.8) 35 (13.5) 82 (15.6)
Table 2. Wound Culture Results at Baseline.*
TMP-SMX Group
Clindamycin Group All Patients
Culture Result (N = 260) no. of
(N = 264) (N = 524)
patients (%)
No culture obtained 110 (41.7) 118 (45.4) 228 (43.5)
Culture obtained but no growth 6 (2.3) 6 (2.3) 12 (2.3)
Culture obtained but no results 4 (1.5) 3 (1.2) 7 (1.3)
Positive culture 144 (54.5) 133 (51.2) 277 (52.9)
Staphylococcus aureus 108 (40.9) 109 (41.9) 217 (41.4)
MRSA 84 (31.8) 83 (31.9) 167 (31.9)
Clindamycin-resistant 12 (4.5) 9 (3.5) 21 (4.0)
TMP-SMXresistant 1 (0.4) 0 1 (0.2)
MSSA 25 (9.5) 27 (10.4) 52 (9.9)
Clindamycin-resistant 3 (1.1) 3 (1.2) 6 (1.1)
TMP-SMXresistant 0 0 0
Streptococcus pyogenes 3 (1.1) 5 (1.9) 8 (1.5)
Group B streptococcus 1 (0.4) 1 (0.4) 2 (0.4)
Beta-hemolytic group C streptococcus 2 (0.8) 0 2 (0.4)
Beta-hemolytic group F streptococcus 0 1 (0.4) 1 (0.2)
Nongroup A and B beta-hemolytic streptococcus 1 (0.4) 0 1 (0.2)
Viridans group streptococcus 9 (3.4) 9 (3.5) 18 (3.4)
Enterobacter species 1 (0.4) 0 1 (0.2)
Enterococcus species 1 (0.4) 1 (0.4) 2 (0.4)
Escherichia coli 2 (0.8) 2 (0.8) 4 (0.8)
Hemophilus species 2 (0.8) 2 (0.8) 4 (0.8)
Klebsiella species 1 (0.4) 2 (0.8) 3 (0.6)
Lactobacillus species 2 (0.8) 0 2 (0.4)
Proteus mirabilis 9 (3.4) 1 (0.4) 10 (1.9)
Bacterial growth not otherwise specified 2 (0.8) 0 2 (0.4)
Coagulase-negative staphylococcus 19 (7.2) 19 (7.3) 38 (7.3)
Diphtheroid bacilli 8 (3.0) 7 (2.7) 15 (2.9)
Other 11 (4.2) 7 (2.7) 18 (3.4)
Hasil
Karakteristik Subjek
Karakteristik n (%)
Riwayat keluarga
- DMT2 18 (19,6)
- CVD 6 (6,5)
- Stroke 2 (2,2)
- Hipertensi 30 (32,6)
- Obesitas 58 (63)
- Tidak ada 20 (21,7)

Acanthosis nigrican
- Positiv 66 (71,7)
- Negativ 26 (28,3)
Karakteristik Gejala
Gejala n
Snoring 7
Kesulitan bernapas 18
Mudah lelah 5
Nyeri sendi 2
Nyeri dada 3
Jerawat 10
Tidak ada gejala 60
Karakteristik Subjek
dengan Resistensi Insulin
Karakteristik n (%)
Jenis kelamin
- Laki-laki 15 (42,8)
- Perempuan 20 (57,2)

Riwayat keluarga
- T2DM 6 (17,1)
- CVD 3 (8,6)
- Stroke 0
- Hipertensi 12 (34,3)
- Obesitas 24 (68,6)
- Tidak ada 6 (17,1)

Acanthosis nigricans
- Positiv 25 (71,4)
- Negativ 10 (28,6)
Faktor-Faktor yang Berhubungan
dengan Resistensi Insulin
Resistensi Insulin
P value OR 95 % CI
Positiv n=35 Negativ n=57

Jenis kelamin, n (%) 0,673 1,2 0,514 2,801


- Laki-laki 15 (42,8) 27 (47,4)
- Perempuan 20 (57,2) 30 (52,6)

Riwayat penyakit 0,646 1,289 0,435 3,816
metabolik keluarga, n (%)
- Ya 29 (82,9) 43 (75,4)
- Tidak 6 (17,2) 14 (24,6)

Riwayat obesitas pada 0,579 1,273 0,521 3,111
keluarga, n (%)
- Ya 24 (68,6) 34 (59,6)
- Tidak 11 (31,4) 23 (40,4)

Riwayat T2DM pada 0,646 0,776 0,262 2,297
keluarga, n (%)
- Ya 6 (17,1) 12 (21)
- Tidak 29 (82,9) 45 (79)

Riwayat hipertensi pada 0,788 1,13 0,462 2,764
keluarga, n (%)
- Ya 12 (34,3) 18 (31,6)
- Tidak 23 (65,7) 39 (68,4)

Acanthosis nigricans, n 0,959 0,976 0,384 2,482
(%) 25 (71,4) 41 (71,9)
- Positiv 10 (28,6) 16 (28,1)
- negativ
Hubungan Resistensi Insulin dengan
Komponen Sindrom Metabolik

Komponen P OR (95% CI)


value
Gula Darah Puasa 100 0,05 5,690 (1,079
mg/dL 0,213 29,993)
Hipertrigliseridemia 0,996 1,880 (0,690
Kadar HDL rendah 0,402 5,120)
Obesitas sentral 0,710 1,003 (0,368
Hipertensi 0,636 2,773)
Kadar LDL tinggi 1,574 (0,542
4,570)
1,182 (0,490
2,848)
Analisis Multivariat Resistensi
Insulin dengan Sindrom
Metabolik
Variabel koefisien P OR 95 % CI
value
Step 1 Gula Darah Puasa 100 1,669 0,051 5,30 0,995 28,
mg/dL 0,535 0,312 9 329
Hipertrigliseridemia -0,754 0,004 1,70 0,606 4,811
Konstan 7
Step 2 1,739 0,040 0,47
Gula Darah Puasa 100 -0,640 0,005 0 1,079
mg/dL 29,993
konstan 5,69
0
0,52
7
Kesimpulan
Prevalensi tinggi resistensi insulin (RI)
pada remaja obesitas, dan resisten insulin
(RI) meningkatkan risiko pradiabetes.
Dengan demikian, strategi pencegahan
dibutuhkan untuk mengatasi dampak
jangka panjang dari obesitas pada
kesehatan.
Terima kasih